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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602288
Report Date: 02/03/2023
Date Signed: 02/03/2023 01:54:11 PM

Document Has Been Signed on 02/03/2023 01:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:BRIGHTSIDE RESIDENTIAL INCFACILITY NUMBER:
198602288
ADMINISTRATOR:DUKES, KIPCHOGEFACILITY TYPE:
735
ADDRESS:517 RICHBROOK DRIVETELEPHONE:
(909) 622-5603
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 4CENSUS: 4DATE:
02/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kip DukesTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPA) Elizabeth Irra and Tena Herrera conducted an unannounced annual inspection. LPAs were allowed by Kip Dukes. LPAs explained the purpose of today's visit.

There are (4) clients residing at this home. This single story home consists of (3) bedrooms, 2 bathrooms, living room, kitchen, dinning area and attached garage. All clients receive case management services provided by San Gabriel Pomona Regional Center.

The following were observed/inspected:
  • COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility.
  • Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.
  • PPE supplies observed. Hand sanitizers observed throughout the common areas.
  • Restrooms have hand soap, hand sanitizer and paper towels.
  • Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Additional food supply observed inside the garage.
  • Water supply observed (including emergency water supply).
  • Per Administrator, all (4) clients are fully vaccinated and have their booster.
  • Per Administrator, all staff are fully vaccinated and have their booster.
  • Medication reviewed for (4) Clients (Client #1 through Client #4).
  • Staff responsible for direct care and supervision will wear masks.
  • Clients were being socially distanced according to local public health guidelines.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Kip Dukes.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/0202
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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